Neti Pot Once a Day Can Cause Infections

MIAMI -- Contrary to popular belief, irrigating the nose every day with the help of a Neti pot may actually make patients more susceptible to sinus infections, researchers said here.

Those who stopped using the nasal saline wash on a regular basis had a 62 percent decrease in the frequency of acute rhinosinusitis, Dr. Talal M. Nsouli, of Watergate Allergy & Asthma Center in Washington, and colleagues reported at the American College of Allergy, Asthma, & Immunology meeting here.

"I don't have anything against short-term nasal saline irrigation -- even aggressive nasal saline irrigation for three, four days or one week is totally fine," Nsouli said. "But when we are doing it on a daily basis, we are modifying the immunological biochemistry of the nose."

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That, he said, can result in a "depletion of immune elements" -- hence, recurrent sinus infections.

"This will lead us to a vicious cycle," Nsouli said. "More infections, more nasal saline; more nasal saline, more infections. We need to cut this cycle."

If people are using the Neti Pot to prevent infections because they get them frequently, investigators said, physicians should find out why they're being infected in the first place.

This type of nasal irrigation has ancient roots, and the form most popular today has stems from an Ayurvedic technique known as jala neti.

The container used to administer the saline solution, which typically has a long spout and resembles an oil lamp, is called a Neti pot, from the Sanskrit term for "nasal cleansing."

Nsouli and colleagues said they conducted the study because, despite its popularity, this type of nasal saline irrigation had not been assessed for efficacy.

The researchers recruited 68 patients who had used nasal saline irrigation frequently for a year, then discontinued the practice for a year. A total of 24 control patients who continued to wash out their noses with salt were also included.

The investigators found that 62 percent of people had a significant drop-off in the frequency of their rhinosinusitis infections after discontinuing the treatment.

Those patients also had 50 percent fewer sinus infections than those who remained on the nasal saline irrigation therapy.

Nsouli said the likely explanation is that irrigation depletes the nasal mucus, which contains several key defense mechanisms -- including immunoglobulin A, immunoglobulin G, lactoferrin, and lysozyme.

This "good mucus," Nsouli said, contains "antibacterial, antifungal, and antiviral agents that clear any microorganisms from the nose."

Dr. John J. Oppenheimer, of New Jersey Medical School, said the results don't mean nasal saline irrigation is "not something to consider if you have a cold."

It's just "not necessarily good on a day-to-day basis," he said.

Still, it needs to be studied when applied to acute situations, he said, and he'd "feel more comfortable seeing the results replicated."

But Oppenheimer noted that the study is an example of how taking the time to ask patients questions about their history and current habits can potentially be a key to treatment.